Medial Epicondylitis (Golfer’s Elbow)

Golfer’s elbow (medial epicondylitis) is a painful condition of the elbow caused by overuse and aging. Golfer’s elbow is “wear and tear” of the tendons that join the forearm muscles on the inside of the elbow. These tendons help you bring your wrist and fingers down (flexion). The forearm muscles and tendons become damaged from overuse — repeating the same motions again and again. This leads to pain and tenderness to pressing on the inside of the elbow.

Anatomy:

Your elbow joint is a joint made up of three bones: your upper arm bone (humerus) and the two bones in your forearm (radius and ulna). There are bony bumps at the bottom of the humerus called epicondyles. The bony bump on the inside (medial side) of the elbow is called the medial epicondyle.

The muscles and tendons that is usually involved in golfer’s elbow are called the common flexor tendons.

Medial epicondylitis, or golfer’s elbow, involves the muscles and tendons of your forearm that help you flex your wrist and fingers. Your forearm tendons — often called flexors — attach the muscles to the medial epicondyle.

Cause:

Overuse	When the common flexor tendon is weakened from overuse, microscopic tears form in the tendon where it attaches to the medial epicondyle. This leads to degeneration and pain.
Activities	Participation in recreational activities or working in a more physically demanding job can lead to repetitive damage to the forearm muscle.
Age	Golfer’s elbow occurs most commonly in ages 35-60, however, anyone can get golfer’s elbow.
Unknown	Without evidence of overuse, activities, and age, golfer’s elbow can have an unknown cause.

Treatment:

Nonsurgical Treatment
Approximately 95% of patients have success with nonsurgical treatment. These treatments include:

Rest from aggravating activities.
Physical therapy to stretch and strengthen the muscles of the forearm. Your therapist may also perform ultrasound, ice massage, or muscle-stimulating techniques to improve muscle healing.
Elbow strap helps rest the muscles and tendons.
Wrist Splint forces you to stop flexing the wrist, thus resting the flexor tendons
Steroid injections help with the pain, but this is usually temporary (about 6-8 weeks). Steroids do not “fix” the problem, but temporarily make you feel better. I recommend against receiving more than 2 injections per site, to avoid tendon injury.

Surgical Treatment
Because of the success of advanced, noninvasive treatments, I do not operate on golfer’s elbow nearly as often as I used to. However, if symptoms do not respond after 12 months of nonsurgical treatments, surgery remains an option for you. This involves making an incision over the inside of the elbow, removing the diseased tendon, and repairing the other portions of the healthy tendon. This is an outpatient surgery that allows you to go home the same day. After surgery, exercises are started to stretch the elbow and restore flexibility. Gradual strengthening exercises are started about 6 weeks after surgery.

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Medial Epicondylitis (Golfer’s Elbow)

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